Should I listen to the GP, or the HV?

[DanielsMummy2016]

Hi I'm new to Mumsnet, it's lovely to be here.

I have a little boy, who is now 3 months. I have been really struggling with BF, sore nipples (I had flat nipples anyway, so went to a few classes for support/advice, midwife recommended it) feeling heavy/swollen, etc.

HV tells me that I'm doing fine, I just need to keep going.

GP tells me that he is on the 0 percentile for weight, he was on the 15th when born. So I just need to give him a bottle really.

What would you do?

[MEgirl]

Have you tried different feeding positions to see whether it makes any difference. Lie on your side with the baby along side you or have the baby facing you with his feet towards the back of the chair/sofa. Not all positions suit all babies.

I agree with others that you would benefit from seeing a lactation consultant and the Kellymom website was very helpful for me.

[MrsMulward]

I used a lactation consultant who was brilliant - both mine had tongue ties. I mixed fed my twins till they were 9 moths really happily (although I did have to come to terms with not EBFing). It doesn't have to be one or the other

[MiscellaneousAssortment]

Good luck whichever you decide.

Making this kind of decision can be so emotional and you can be torn in different directions. But try to remember it's doesn't have to be the end of breast feeding, so please try not to worry too much.

I don't know quite what the situation is, as another poster has written, it makes a big difference whether your little one is dropping weight rapidly and is plunging down through the centiles, or whether your baby dropped some centiles and has stabilised at a very low centile.

[kurlique]

I mixed fed both my DCs, in order to preserve my sanity... BF DS to 6mths at which point he had lots of teeth (aka a guillotine) and preferred steak & chips well, solids but DD went on BF for MUCH longer... despite what people may say, it is a viable option.

[Pettywoman]

This happened to me. DS1 didn't gain back birth weight for 6 weeks whilst I struggled on breastfeeding in agony, cracked, sore, mastitis crying. In the end I gave one bottle of formula a day and he began to gain weight and we both relaxed. Breastfeeding all came together for us and ds was breastfed for 14 months, with a few bottles here and there.

In my experience it is worth sticking with bf, just because it is cheap, portable and once established relatively easy. Formula helped me loads though. Do what you feel you need to and don't feel bad about it.

[bigmamapeach]

It's a bit unclear what the situation might be and I'm wondering if a second medical opinion might be a good idea, either a separate gp or asking if gp can get a paediatric opinion. As some folks have said you can't be on the zero centile, this doesn't exist this is just about how the statistics works. You can be on or below the 0.4 centile but that might indicate (not sure) a drop thru 2 centile spaces which normally would entail getting specialist advice as it can be concerning. But not clear if that's what has happened here. Also ? Has baby actually lost weight or been steady gaining on a centile, but just happens to be a small baby? A lot depends on these things and when the drop happened from birth centile plus other considerations...
I sort of feel you want to be safe so possibly need more medical input. All the suggestions for more bf support sound good to me if you are going that route.

[bigmamapeach]

sorry to drip feed, wonder if you would ask MN HQ to move this to the "breast and bottle feeding" forum, as there are lots of people with lots of knowledge who post on that who could help you?

I sort of felt (am currently training in BF support, but not as knowledgeable about these things as many others), that there can be a complex picture around baby growth, and there are possible alternative explanations with different approaches to then take; a baby who is "genetically little" and is happily growing steadily on their curve - which is fine and does not warrant supplementation; and alternatively, there can be situations where there are problems (not necessarily with milk supply although it can be that), but things around baby's health or even mum's health that need a full picture and careful assessment to evaluate and work out what is going on and what the most appropriate path forwards might be. Only a good HP who knows both your and baby's health background and can assess both, can work with you to do that and then plan to get your BF support lined up when you have a clear plan of action. It wasn't clear to me that either GP or HV had really given this in depth thought to be honest, I am sorry!

you have done a huge amount to EBF to 3 months, more in terms of immune support for baby than many babies in the UK get, so kudos to you for working through that, and if you do end up supplementing now or later, you can still continue to BF as long as you want and one way to think about that is just as additional support to help you to BF still if that is what you want to do. Nursing supplementer (someone mentioned, you may need hands on skilled help to demo it) can be a good way of introducing the supplement, to keep stimulation at the breast and baby's breastfeeding skills continued.

[Velvetdarkness]

I'm a bf supporter. You need to speak to someone and let them see the growth chart. I'd want to know what the birth was like, were you on iv fluids (which artificially inflate birth weight) what has weight done since, what are nappies like, is baby alert etc.
You can call the national breastfeeding helpline today for help and they can also look up your local drop in where you can see someone.
Your HV will know more about bf than your GP but still may not know much. Bf supporters are trained purely in bf and know lots. And a lactation consultant knows even more, if you can afford one.
But start with the free helpline and drop in.

[Boiing]

I suggest you express and feed some of the breastmilk from a bottle - this may be easier for the baby to drink and also it will help you see how much you are producing/ baby is drinking.

• if that doesn't help, try formula as well, but do not completely give up bf. If you are feeding bf even just a little bit each day, then later you can go back to exclusively bf if you want, when baby has got more efficient at it (baby is learning too and will get soooo much better and quicker at it). Bf is a godsend when they're ill.
  
• eat lots of oats/fat to make sure your milk is good. (Do not eat spicy foods by the way, I learned that the hard way.)
  
• go to drop in bf clinics
  
• get baby checked for tongue tie
  
• have baby on your chest as much as possible - put your feet up for a few days.
  

Much depends on whether your baby is generally healthy / if family were low centile or not. I've know 2 babies who were at the bottom of the centile chart for first few months. One baby had tiny parents (both 5 ft) and now he is 4 he is still bottom of centile - that's just his genes. The other baby was massively malnourished because the mum was determined to ebf and didn't realise she was producing almost no milk, that baby went up to middle of centile charts once on formula. (In my view her supply problem was because she would only feed every 3-4 hrs and bf doesn't work well like that).

In general your GP is right that you have to try to get baby's weight higher, and using a bottle is not a bad idea - but there's no reason to put formula in the bottle rather than breastmilk.

[HornyTortoise]

Always listen to qualified professionals over a health visitor on matters such as this. HVs advice tends to come from a place of opinion...

[5moreminutes]

Horny sometimes a health visitor is a better qualified professional than a GP when it comes to advising on feeding a baby -

A health visitor is a qualified nurse or midwife with post-registration experience who has undertaken further training and qualifications in child health, health promotion, public health and education.

Some GPs have a special interest in children or infants, some in very different areas of health, and none have an in depth knowledge of every type of health issue for every section of the population. Some GPs did their only training in issues related to infant feeding decades ago... Some GPs will be very knowledgable about infant feeding and others will be not a lot more use than a random fairly intelligent woman on the street or MN who happens to have breast fed her children and is capable of using google... tbh.

I have no idea which to listen to - it would depend on the individual not just their job title, and whether they seemed to be talking sense IMO.

The best advice on the thread is to seek further more specific expert opinion - there are lots of links on the thread if the OP ever comes back to it...

[Kennington]

Express while you decide what you want to do.
I agree kellymom and la leche league are worth a look
NUK teats are perfect for mix feeding, which is what I did for over 2 years. They are low flow so resemble breast milk flow. I got them from Amazon.

[bikerlou]

Personally I'd go and get a bottle before my baby got any thinner.

However you shouldn't be asking us or relying too heavily on your HV, I think they are way too obsessed with breast feeding, you should be looking at your baby and yourself and doing what feels right for both of you.

There seems to be a thing now where everyone seems to be tellling mums what they "should" be doing and making them feel guilty about it but mums need to be relying on their own instincts. Is your baby thin and hungry? Are you in pain? Then what do you think you should be doing?

I had my baby at a very immature 21 and did exactly what I felt was right and he is for us and he is an adult now and very happy and healthy. Mums know what is best for their baby and it's nobody else's business.